YOUR BEST FRIENDS’ BLOG


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November 27, 2020 Blog News0

Horses can suffer musculoskeletal pain and injuries anywhere along the axial skeleton that comprises the skull, vertebral column, sternum, and ribs. Bringing these horses back to form and into work post-injury can be difficult, time-consuming and super frustrating, but possible thanks to both time-tested mobilization exercises and rehabilitation techniques.

After a thorough clinical exam and movement evaluation, the first technique of rehabilitation  is to obtain progressive movement and mobilization of the affected areas. The main idea behind rehab, is to restore a horse’s normal motion.

Owners can perform various mobilization techniques when the horse is cold (before being exercised), warming up, and warmed up.

Cold exercises include:

Stretching exercises such as carrot stretches to engage the cervical and thoracic spine

Massage

Walking in-hand forward, backward, and on a figure-eight;

 

When the horse is warming up:

Electrical stimulation – NMES or TENS

Applying weighted boots around the hind pasterns to improve proprioception ,increase hip, stifle, hock, and ankle flexion;

Working on a longe line with a training device—such as side reins, a chambon, a gogue, or a pessoa rig—to encourage the horse to move and use his body properly. The trainer or rider will need to be trained to use these aids effectively.

And once the horse is warmed-up:

  • Working on different footings and slopes: Uphill work promotes engagement and abdominal wall contraction. Downhill work increases passive engagement and will be challenging for horses suffering from sacroiliac joint disease. Deep footing will make the horse elevate its hind limbs more. Firm footing increases vibration and is not indicated for horses with joint or bone diseases such as kissing spines and facet joint disease.”
  • Trotting over poles to induce conscious proprioception and more hip and gluteal muscle function.

The exercises or training done under saddle is very dependant on what are is being rehabilitated:

 

Thoracic pain Allow these horses to move freely on the longe line as part of their warm-up, because they tend to counterbend when cold. Make sure the line is loose and the circle size large – greater than 20 meters. Avoid using a surcingle, which can increase longissimus muscle tension, supraspinous pain, and kissing spines issues. The choice and fit of saddle is paramount for this type of back issue

 

Thoracolumbar and lumbar pain Walk these horses for a long time ( approx. 20 mins) before trotting. Some horses feel better cantering instead of trotting because there is less axial movement of the spinal column,   canter for a couple minutes in each direction before trotting. In cold regions or seasons cover the back area with a warm rug while working.

 

Lumbosacral and pelvic or sacroiliac pain Walk these horses for 20 mins before working and canter briefly before trotting. Under tack  perform  progressive half passes to engage the pelvis after warming up. Don’t work in tight circles, instead  work on concentric circles (starting 50 to 60 feet wide and getting progressively smaller) to encourage the horse to bend more and lean in less, ultimately pushing more with his inside hind leg.

 

Modalities are helpful to ensure success:

 

  • Massagecan increase blood flow and relieve muscle spasms. Many massage techniques are available, but this would be the first modality to offer to owners and grooms working on their own horses.

 

  • Lasercan be used to stimulate specific myofascial trigger points and aid healing.
  • Therapeutic ultrasoundcan increase blood flow, relax muscles, and stimulate trigger points. Kinesiotape applied to limit certain joints’ movement can relax or strengthen muscles, support ligaments, stimulate circulation, and decrease inflammation, depending upon how and where it’s applied.
  • Electrotherapyuses various instruments—such as transcutaneous electrical nerve stimulators, interferential stimulators, neuromuscular and functional electrical stimulators, galvanic muscle stimulators, and microcurrent electrical stimulators—to stimulate nerves and decrease pain.
  • Shock wave therapycan help treat myofascial pain and muscle spasms.
  • Magnetic therapymight enhance blood vessel formation.
  • Cryotherapyusing anhydrous nitrogen can stimulate and relax sore muscles.
  • Hydrotherapy, including water treadmill use and swimming, helps the horse strengthen his muscles without overloading the limbs if, say, he also had surgery recently.
  • Saddle adjustmentto ensure a proper fit can help avoid or eliminate muscle spasms.

Some of these techniques are being scientifically evaluated, but practitioners have used many of these tools to help horses recover quicker. The main techniques used today are massage, TENS therapy, and stretching; however, functional electrostimulation and therapeutic ultrasound or kinesiotaping can hopefully be used for other serious issues in the future.

Owners should work with their veterinarians and other practitioners  to determine which rehabilitation techniques and exercises are appropriate for their particular horse’s injury and discipline. Back problems are often linked to lower limb issues. Working with your veterinarian to ensure the horse remains sound and monitoring the horse’s topline muscle for any asymmetries.

 


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November 13, 2020 Blog News0

Physical therapy, chiropractic, myofascial work and rehab can be incredibly effective on certain conditions, especially when done by someone who understands when and what to do. Some of these conditions include:

  • Osteoarthritis;
  • Bucked shins, splints, curbs, and some fractures, such as otherwise “untreatable” pelvic fractures;
  • Injuries or paralysis of the suprascapular nerve, which innervates some of the shoulder muscles;
  • Muscle atrophy;
  • Muscle injury/damage following trauma or surgery;
  • Tendon injuries (acute and chronic);
  • Stifle weakness and dysfunction
  • Spinal dysfunction and back pain
  • Recovery from neurologic disease such as equine protozoal myeloencephalitis (EPM) or equine motor neuron disease;
  • Acute and chronic wounds
  • Disuse contractures or atrophy during stall rest or immobilization
  • Neck, truck, and limb inflexibility;
  • Loss of performance.

Although many  owners, trainers, and veterinarians support using PT, chiropractic and rehab practitioners in horses, some members of the equine industry remain wary. The “science” behind physical rehabilitative disciplines in equine medicine is as inconsistent and unclear as it is with other complementary and alternative therapies, such as nutritional supplements and acupuncture.There are a number of reasons for this, the primary being that you cannot create a pill or procedure for these physical disciples, therefore there is no financial backing for good research by the pharmaceutical companies.Yes I did just say that and it’s because it’s true. Extracorporeal shock wave, under water treadmill and cold laser companies are offering some small funding but its fairly dismal compared the to billions the pharmaceutical companies have t throw at research.  For that (lack of research) reason these disciplines have not been fully integrated into the care and husbandry of horses, despite the large number of medical and surgical conditions that equine physical therapists and rehabilitation professionals suggest are amenable to PT.

What is physical therapy/ rehab etc?

Physical therapy helps a horse recover from injury and  re-educates an injured body part to move or function normally. Rehab/PT includes the use of various modalities such as heat and cold, hydrotherapy, therapeutic ultrasound, extracorporeal shockwave therapy, cold laser, manual soft tissue and electrotherapy.

Lets look at these modalities:

Hydrotherapy  Swimming and specialized under water treadmills have also become very popular. They allow rehabilitation in a buoyant environment which allows for endurance training without impact on affected joints.

Cold therapy,  involves applying water to an injured area to encourage healing. Cold hosing an injury to reduce inflammation is one of the simplest forms of cold therapy. It helps reduce swelling in a recent injury and can also be accomplished by pressing or wrapping ice packs around an affected area.

Heat therapy, on the other hand, causes blood vessels to dilate, increasing blood flow to the injured site to maximize healing. This therapy is used after pain and swelling subsides. Hot compresses, or a soaking boot (for lower limb injuries), among other approaches are effective for applying heat.

Therapeutic ultrasound involves using high-frequency sound waves to raise the temperature of selected deep tissues without heating the horse’s skin. Ultrasound is used to treat musculoskeletal injuries and promote wound healing.

Laser therapy employs infrared wavelengths to stimulate normal cell activity that has been injured. This method is most commonly used to treat soft tissue injuries, joint pain and to repair wounds.

Electrotherapy is the application of an electric current via surface electrodes to produce controlled movement of the skin, muscle, tendon, and associated ligaments. There are two main types of electrotherapy devices: sensory nerve or motor nerve stimulators that work on different pathways and have different therapeutic uses. NMES and TENS have different therapeutic properties and work on different physiological pathways.

Extracorporeal shockwave therapy is a shock wave is an acoustic (pressure) wave with very high amplitude and rapid rise time. There are multiple ways to generate a shock wave. While the exact mechanism is not yet known, ESWT commonly leads to improved circulation due to blood vessel dilation in and around the injured area. Growth of new blood vessels has also been recorded.

Significant pain relief is almost immediately evident, although slight swelling and sensitivity may be noticed for a few days. ESWT also has a positive effect on the concentration of transforming growth factor beta 1, which stimulates cell activity. In addition, ESWT influences bone remodeling by thickening the outer layers and strengthening the cell network underlying joint cartilage.

The best results have been seen in horses with hock problems and proximal suspensory ligament injuries. Stress fractures, ringbone, navicular syndrome, back pain, and tendon injuries have been treated with variable results.

Despite the widespread availability and use of rehabilitation modalities, machines cannot replace a rehabilitation specialist’s own hands, skill sets, and problem-solving abilities. Biomechanics and gait evaluations and exercises as well as a full physical exam will determine what course the treatment will take. These treatments  will improve the horse’s biomechanics and re-educate muscle memory, which will help heal the current injury as well as assist in preventing reinjury.

Controlled physical activities, such as using a treadmill, underwater treadmill, and/or mechanical walker, schooling and swimming, for example, are also widely employed. These, along with manual techniques such as massage, stretching, chiropractic adjustments, myofascial dry needling and core stability training, are often employed in the successful rehabilitation of an injured or post-surgical horse, to assist performance horses during competition, and even aid mares during the postpartum period.

Physical therapy should not be assumed to bring the horse back to pre-injury status, but should be viewed as a means to help heal the injury or surgery to the best possible outcome. Further, once a condition has become chronic, it will be more time-consuming and challenging to return to the horse to his previous level of performance.

Dr Hilary Clayton and colleagues are studying the effects of core training exercises on the horse’s neck and back. Clayton’s research has shown that performing baited stretches (“carrot stretches”) regularly over a three-month period can activate and strengthen the muscles that support and stabilize the horse’s back. These study results were published in the Equine Veterinary Journal in 2010 and 2011.

Kevin Haussler, DVM, DC, PhD, from the Orthopaedic Research Center at Colorado State University, is also making impressive headway in this field. Recently, Haussler and colleagues described their assessment chiropractic on the spine and concluded that it can improve spinal flexibility in actively ridden horses.

For rehabilitation to be successful in horses, it should not just rest on the shoulders of the specialist; it should involve the veterinarian, farrier, trainer, owner, barn manager, feed specialist, and saddle fitter, just to name a few. The key is putting all of our heads together to come up with an excellent rehabilitation plan.

 


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October 30, 2020 Blog News0

Ok ok we know you’re smart and you want the whole world to know it, but you also want to be PC and not offend anyone with whatever may offend them ( the list is endless by the way), so how do you communicate with your client.

First off, your client wants to know that you are in control and you have a plan. You don’t have to be pushy or a know it all, just be honest and frank with patients, without bringing emotion into it.

1.Stop trying to be the smartest person in the room and telling everyone you are.“The biceps tendon originates from the supraglenoid tubercle…”  Nobody else cares how much you know.  They need you to explain it to them in a simple language they can understand.  So, try to come up with ways to explain things in simple, descriptive terms. Use visuals and analogies.  You want to connect with your patients and clients, not show off your knowledge or how many big words you know!  Now, don’t dumb it down to the point that you’re just glossing over everything, but learn to read your audience correctly.

2.“Because I said so.” Or even worse “ because Im a doctor”. If you want your clients to tune out right there, congratulations you got it! Providing treatment or prescribing exercise without providing an explanation as to how that treatment or exercise connects to the therapeutic goals is a phenomenal way to turn off even your most engaged clients. Be sure to explain the reasoning behind your treatment and exercise prescriptions.  Communicate with your clients, don’t talk at them, they will switch off in a heart beat and not return, no matter how much you know or how good the service is that you provide. People want to be heard.

3.“You could be doing better.”  Your clients are not children who need to be ridiculed and admonished. All you end up doing is isolating them from you and creating a hostile environment. Blame is never helpful.  Start with focusing on the good things and the progresses that their pet is making.  If you need to point out where the client  is hindering healing, then do so gently and kindly.

  1. “Sure you can do that why not?!” Allowing a client to dictate their care plan.  This one can be tricky.  Canine healthcare funds come out of a family’s monthly budget, and that can be hard for people to balance.  However, you are the expert, which means that it’s up to you to advise what would be best for a patient. Offer a number of alternatives, gold, silver and bronze standard and let them decide what they can afford to do without you guilting them into it. Usually the latter of those includes tons of homework, home exercises, etc., and a lecture about how the clients are now primarily responsible for any progress.  And that I want them back at a specific date. This way, I’m still in charge of what gets done in each scenario.

5.“ Sure come back whenever!”.”  Don’t let your clients leave without knowing your thoughts on the best follow-up course of action.  Even in the case of ‘management-only-patients’:  “This time frame seems to be good. Or, if your patient has deteriorated,  “Let’s see him a little sooner next time”.  Rehabilitation is a marathon, not a sprint.  This means that you need your clients to ‘buy into a long game’, do their home exercises, and come back!  To accomplish this you need to have a trust relationship with the client. Communicate your plans, your next steps, your thoughts, and engage the client with regards to their goals.

Be cautious and conscious of the words you choose to speak. You may not remember them, but your clients do.

 


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October 16, 2020 Blog News0

Starting a new business of any kind is super tough, especially life AC ( after covid). It would be wonderful if, after you qualified, you could hang a sign outside your door and clients would just flow in and all the veterinarians would refer to you because they see so much value in what you have to offer, but alas this is not how it happens.

It is slow, arduous and you have to have tenacity and keep your sense of humor.

Here are a couple of ideas to help you get the practice you want

  • Network as much as possible. Introduce yourself to the vets you would like to cultivate a relationship with, spend some time with them, discuss cases and even possibly go with a patient & client to their follow up appointment which shows that you care and are interested.
  • Over-communicate.  Send your detailed notes, call them, discuss concerns and triumphs with them.
  • Be humble, leave your ego and self esteem issues at the door and let them know that you want to learn from them.  This is particularly important in communicating with the surgeons, but also for anyone in rehab when communicating with the general practice DVM.  On one hand, it panders to the other person’s ego and you might have something to truly learn from them as well! Fighting a specific point to death does not foster good relationships. Pick your battles and be careful what words you choose

The final comment was to be aware that building a rapport is cumulative.  So it’s going to take time, consistency, humility and many many success stories.  But it can be done!

Know what you know and know what you don’t know and work to your strengths.

Knock their socks off


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October 2, 2020 Blog News0

Why are some physical activities fun for some people, but not for others?   I hate running, but I love lifting weights. Bike riding hurts my wrists, neck, and butt, but I love hiking and walking in the mountain.  I hate spin classes but hate HIIT sessions.

There might be movements or activities that are generally thought by the greater population to be fun:  going down a water slide, sledding or skiing down a hill or walking in a beautiful park with people you love.  I think the majority of people would find these things to be fun.

In the same way, there are going to be some movements that some patients love and are motivated by, and others that rebel against the very idea of it!  All creatures are built with an inherent risk-reward measurement system when it comes to movement & expending of energy.  A rabbit is not going to aimlessly run around burning up essential calories just for fun, they stay hunkered down in the grass and if danger approaches in the form of a fox or another predator they will run like the wind burning up every calorie to prevent from being eaten.

The same can be true for prescribing movements or treatments that feel good or are enjoyable as part of a therapy plan versus prescribing your “routine exercises” or the underwater treadmill just because you have it and need to pay it off, or you don’t feel like doing anything else with them that day because you’re tired or have a headache. Rather we should be finding exercises that your patient and client can enjoy! Possibly, the dogs having a good time is a  missing element that could take your therapeutic exercise sessions from good to phenomenal?!

When I enjoy something, I put my 150% into it.  That makes a significant difference to how I perform, improve, and grow? Why would it be different for our animal patients? I don’t think it is..

We need to figure out what motivates them?  What movements or activities do they already do and enjoy?  If it’s a sporting dog, can you incorporate sporting activities into their rehab?  If they know tricks, can they be incorporated? What is their “love language”, so to speak? Is it the attention from their owners, food, words of encouragement, owner involvement etc, then let’s use that to motivate them.

Make it about your patient!  Not about you, the owner and your convenience or preferences.  Try it and see what happens

 

 

 

 


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September 18, 2020 Blog News0

WE are continually being bombarded with social media, advertising and publicity regarding food, supplements and products for our beloved 4 legged family members, but how do we know what is legit and what just makes expensive urine??

I was poking around on google and came across this awesome article that answers lots of those questions.
The article on this subject is available at:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6570027/

Menchetti L, Guelfi G, Speranza R, et al.  Benefits of dietary supplements on the physical fitness of German Shepherd dogs during a drug detection training course.  PLoS One. 2019 Jun 14;14(6):e0218275. 

So to summarize, the researchers fed 7 dogs their basic basal diet, and a different set of 7 dogs the basal diet plus a daily nutritional supplement for 3-months.  All dogs were German Shepherds, 2-3 years of age, all born and reared in the same place, and trained as drug detection dogs.  At the end of the trial, they evaluated heart rate using treadmill exercise and the subsequent recovery period. Blood samples were collected before starting the nutritional supplement treatment, before and after the treadmill exercise and following recovery.

The supplement contained:  Amino acids, carnitine, vitamins, and octacosanol.  (Iken Up, Teknofarma, Torino, Italy)

What were the conclusion?

Answer:  Dietary supplementation proved effective in improving the physical fitness of drug detection dogs by exerting beneficial effects on heart rate recovery, energy metabolism and biomarkers of muscle damage.

Lower heart rate after recovery, lower time constants of heart rate decay, and higher absolute heart rate recovery.

Lower concentrations of creatine kinase (CK), aspartate aminotransferase (AST), & non-estrified fatty acids (NEFA) – suggesting a reduction in muscle damage and improvement in energy metabolism.

How fantastic! I have always been sceptical of supplements, particularly oral supplements due to the acidity of the canine gut and lack of proof of absorption, so I was very pleased to find this study to share with you. It works!

I wanted to see if this study had true validity or if it was a shot in the dark, so I kept searching, and this is what I found:

Pelligrino et al. Physical response of dogs supplemented with fish oil during a treadmill training programme. J Anim Physiol Anim Nutr (Berl). 2019 Mar;103(2):653-660.

In this study, supplementing with fish oil and then training dogs on a treadmill for 30-minutes, twice a week, for 12 weeks resulted in lower heart rate values -pre-exercise and post-exercise, lower post-exercise rectal temperatures, and higher thigh circumference was noted as compared to the control group.

Burri L et al.  Effects of dietary supplementation with krill meal on serum pro-inflammatory markers after the Iditarod sled dog race.  Res Vet Sci. 2018 Dec;121:18-22. 

The blood of two Iditarod teams were compared for omega-3 index, inflammation (CRP) and muscle damage (CK).  One was fed a seafood-based supplement from Krill, rich in omega-3 phospholipids and proteins for 5-weeks prior to the start of the race, and the other group did not receive any supplementation.  The supplementation group had a higher omega-3 index pre-race, did not raise as high in the post-race inflammatory values, and had a tendency towards reduced muscle damage.  However more controlled studies are needed to confirm these findings.

I am still not a total believer in oral supplementation but these studies have definitely made me sit up and pay closer attention. There is definitely a need for more in depth and longer studies regarding supplements but they have shown here to have beneficial effects that may aid in performance and recovery.  So, now if or when your asked about dietary supplements by a sporting dog owner, you can feel comfortable saying that research is showing that they are proving to be useful.

 

 

 


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September 4, 2020 Blog News0

Stairs are a major issue for many dogs. Today we are looking at a few ways you can help your dog conquer these mountains they need to climb, safely and confidently
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1. Grip.
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If your steps are linoleum, tile or hardwood they might be too slippery, especially when your dog is bounding up and down them. One wrong step & your pup could slip and tumble. This may already have happened and your dog now has some confidence issues when approaching stairs
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Solution: Add stick on stair tread to each step to prevent poor grip, loud noise and slippage.

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2. Slings or a help em up harness.
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Larger dogs often experience hip or joint problems as they get older making stairs difficult for them to navigate. When going up the stairs, dogs shift their weight onto their hind quarters making stair climbing a painful activity.
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Solution:  Help take the weight off your dog’s hind legs by using a dog sling or even better a help em up harness! These support their hind, keeping weight off painful and dysfunctional hips, lower back and hind limb joints.  A towel is a cheap but inefficient option, whereas a harness can stay on your dog at all times and be available for sudden slips and slides.

  1. A fearful or insecure dog.
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    Many dogs weren’t desensitized as a pup, so they are unsure and lack confidence about new and uncertain situations.

Solution: There is an excellent possibility that your dog’s love of food or toys, or even you will outweigh their fear of stairs. Place their food bowl next to the stairs. If they eat without hesitation, move the bowl to the first step the next night. Keep up the pattern until your dog is confidently climbing the stairs to reach their dinner. You might need to stay on one step for a few days in a row before they’re ready to move.
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4. Pain and dysfunction.

Some medical issues can make stairs extra tough. Symptoms may be invisible on flat ground. However, once your dog climbs up the stairs, they can be easily spotted and it might be time to visit your vet, rehab specialist and chiropractor. ⠀⠀⠀
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As a chiropractor I will assess to see why they are struggling with the stairs and how can we help them manage them better. Not only will this improve their symptoms but it will address the underlying cause of their refusal. Improving mobility, decreasing interference in nervous system, correcting compensation patterns and managing chronic conditions are all part of chiropractic care of dogs.

 


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August 22, 2020 Blog News0

That sounds like there is a simple answer to that question, but alas, no luck. Stiffness can come from a variety of sources- muscle, soft tissue or joint capsule, so how do we differentiate one from the other.

When confronted with an area of decreased motion, I jump into motion palpation/ joint glides first. First things first, feel for joint play. Where and is there stiffness? Muscles and tendons don’t provide stiffness or resistance in this motion. If you think of an arthritic hip, it will be stiff long before it reaches its end ROM as there is joint capsule tightening.

Then, while doing your ROM, think about the muscles you are concurrently stretching.  Perfect example: shoulder flexion also stretches the supraspinatus tendon and the biceps tendon.  If you start a biceps tendon stretch with the elbow in extension before adding in shoulder flexion, the focus is on the biceps tendon without involving the supraspinatus or the glenohumeral joint.  However, you can move into full glenohumeral extension without putting teres major, latissimus dorsi, deep pectorals, or triceps on stretch if you block scapulothoracic motion.

Remember to always check agonists AND antagonists, R and L – always check both sides of the body so you can get a good feel for your patients normal or abnormal.  How does this joint compare?  Some patients will be hypermobile everywhere and others may be stiff everywhere.  This must be factored in.

If you suspect a muscle or tendon to be involved of if the restricted or painful motion can indicate either joint or a soft tissue structure, then you can palpate the muscle, tendon, ligament to determine if it is painful.

How does Active Range of Motion (AROM) compare to Passive Range of Motion (PROM)?  This is obviously easier to do in a human than a dog, but there are some tests you can do that look at AROM.  Can the dog sit and lie down square?  Those both require full hip, stifle, and tarsus flexion.  The canine shoulder doesn’t lend itself to much in the way of testing full AROM. Remember that  AROM lends itself to a multitude of compensations.  Think of a dog with hip dysplasia, they compensate with stifle or tarsal hyperextension at the ned of stance phase, they circumduct or externally rotate the hip and has a hip/ pelvic drop when walking. A patient can learn how to actively avoid end ranges of the joint by allowing other joints to move more, take on a variation in rotational positioning, or by allowing certain muscles or structures to stretch more or work harder in order to complete the task. Therefore, a reduction in PROM is most likely a joint issue.

Then we come to my favorite place to be-END FEEL!! The end feel is one of the key factors in deciding if the problem is capsular- ligament or capsule, soft tissue apposition-muscle or fat impeding further motion, springy- as felt with a meniscal tear, spasm -indicating an acute injury,  elastic tendon stretching- often hypermobility, boney- such as elbow extension, empty- this is never good!, or facilitation- test for stifle extension in a chronic partial CCL tear case, and you feel resistance to even go into extensiom.  End feels tell you exactly what you are dealing with as far as joint function is concerned.

Keeping all these factors in mind we can arrive at a working clinical diagnosis with which to guide your treatment or the need for a referral for a surgical consult or for further diagnostics.


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August 8, 2020 Blog News0

In practice we see a lot of cranial cruciate ligament (CCL) and patella luxation surgical repairs. They are the most common stifle / knee issues. We used to see a lot of TTA repairs from CCL tears, but TPLOs have become much more popular in the last few years. Something I have noticed is, that if there is a complication of any kind- poor pain management, excessive swelling, infection, plate or screw issues etc, these dogs have a tendency to constantly struggle with the affected leg.

These dogs will often have a permanent limp or off-loading of the surgical limb. In many cases the dog has full stifle ROM, no compensatory areas of pain or dysfunction (sacroiliac or lumbar spine dysfunction, muscular compensations in sartorius or gracilis etc) and appropriate muscle tone, they can still be seen to not fully weight bear on the surgical leg.

The question keeps coming up: Why, why why??

Well, I believe that there are two components in these cases- the psychological and habitual elements.  Prolonged pain can change the central nervous system and cause an overrepresentation of that limb or affected region, in the homunculus of the brain. As a result, any problems occurring in the affected limb becomes amplified when interpreted by the brain. Limb functioning is altered compared to the other side.

When this happens in our canine patients, it’s hard to normalize.  It’s hard to change these compensations in people – with whom we can work on the psychology of pain management. When addressing it in dogs, we likely have to use physical stimulus to change the psychology.

Other factors that I think we need to consider, particularly in sporting dogs and show dogs, is that we may not be getting them ‘sport specific ready’ and are not taking these dogs far enough along in their rehab journey by not prescribing challenging intensity exercises to get them to higher levels of function. Certain disciplines within the dog world- such as show or sporting dogs, also comes with owners that notice the most subtle alterations in gait or weight bearing, turns of the leg, positioning of the foot, bend of stifle, level of the topline and so on.

So, if we look at the component of return-to-sport rehab, we need to learn to prescribe higher levels of exercise (bursts, change of direction, strong muscle contractions, acceleration, deceleration, etc.)

Lets look at an example I had in practice recently:

Ben is a 4 year old golden retriever who had an extracapsular repair and got an infection at the surgical site that lasted for 10-weeks post-op. During that recovery time, Ben never put weight on that leg.  10 months later he will still occasionally toe touch in standing and offload the leg.  (No pain, full ROM, no meniscal tear, no ‘other’ issues… just habitual at this point – I believe.)

Soooooo, what do we do??

  • 1.Manage pain and swelling aggressively early on in the post-operative period.

 

  • 2.Ensure your rehab incorporates advanced strengthening (i.e. UWTM and do ‘bootcamp’ at about the 6 – 8-week mark.)

 

  • 3.Retrain sport-specific tasks.

 

  • 4.Rehab for longer or bring the dog back in for rehab at a later stage.

 

  • 5.We need to be creative and think outside of our protocols and paradigms to break habitual limb use dysfunctions.

 

My plan with this patient is do diversify her activities- possibly introduce some pulling to engage the hindlimb and pelvis, maybe some discipline or IPO for strength and explosive force propulsion, continue with sports specific programs.  What would you do?

 


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July 25, 2020 Blog News0

Several researchers and scholars have asked the question in human medicine: “If my cells are constantly reproducing, why do I still have pain in my back, knee etc?” Excellent question! Bone cells turn over every 3 months, skin cells every 10 – 30 days, and your skeleton in general updates itself by 10% a year! (1) Stem cell research is the forerunner in the fight for regeneration. When we are talking about stem cells I am talking about naturally producing stem cells not injectable stem cells. High cellular turnover seems to protect against aging, however if high cell turnover is in conjunction with cellular mutations, it might also hasten the development of cancer. (2)

The reasons a joint might develop osteoarthritis (OA) is multifactorial.  There might be mechanical damage (i.e. a torn ligament that leads to abnormal joint mechanics), or biochemical damage (i.e. inflammation in a joint leading to cartilage degeneration), or genetic (i.e. which could be a factor of conformation such as elbow or hip dysplasia).

In the early stages of OA, the body is trying to counteract the changes that are occurring. It tries to repair the damage to the cells, quell inflammation and deal with tissue damage. Chondrocytes ability to regenerate cartilage is severly limited and unless this destructive process is halted, the damage will be permanent.

Therefore, early diagnosis is of key importance, since therapies aimed at blocking or reversing cartilage damage will be more effective when there is the possibility of preserving normal homeostasis (i.e. The normal rate of cell destruction, restoration, and remodeling.  This is the ‘turnover’ I was talking about earlier).  At later stages, some different interventions may be required, such as tissue engineering in order to repair damaged cartilage. (3)

Prevention is always better than cure, so lets talk about stopping OA before it starts:

Lets take my dog for example: I have a 160 lb bullmastiff that had an FCE at 2. She has a lasting left hindlimb weakness and neurological deficits. 2 years later she is playing in the yard and she ruptures her R CCL. Was this preventable, maybe, maybe not. If Im honest, I should have done a lot more rehab with her after her FCE but a shoemakers sons aren’t always shod. Mea Culpa! SO I should have been doing preventative work straight after the FCE considering I know better and her gait, constitution and capacity had changed dramatically, opening her up to further injury.

How not to be like me: You can become proactive in preventing osteoarthritis (as best you can)!  You might also want to seek the guidance of a veterinary physiotherapist or rehab vet to help you address each goal.

Laurie Edge Hughes uses these principles to prevent or delay OA( 5 ):

Goal # 1:  Manage the inflammation early.  In a sudden onset trauma, inflammation is what signals the body to repair, but you don’t want the process to continue on for too long, otherwise it can do more harm than good.  So, in the case of a joint injury (versus a muscle or tendon have an honest conversation with your vet and if possible, put your dog on the anti-inflammatory now.  This is an acute treatment, not chronic. but a short-term use of non-steroidal anti-inflammatories is very helpful.  The introduction of other modalities such as laser therapy, dry needling, or pulsed electromagnetic field will help reduce this inflammation.  Rest and remain under supervision: Leash walks only, no playing, no sporting activities.  If this is a genetic condition (i.e. hip or elbow dysplasia), this phase might be shorter than if this is a new trauma (i.e. a torn CCL, or post-surgical condition).

Goal # 2: Stimulate tissue healing.  Laser therapy, extracorporeal shockwave, and therapeutic ultrasound all have an effect on tissue regeneration.  There are some interesting research papers that look at repairing damage to joints in cases where they ‘induced osteoarthritis in mice’ (the researchers made cuts to the cartilage in the mice joints in order to start an inflammatory and subsequent arthritic process).  In many of those studies, they were able to significantly reduce the arthritic changes seen weeks and months later compared to the mice that didn’t receive therapies! (5)

Goal # 3: Strengthen the surrounding muscles (after the acute inflammatory phase is over).  Strengthening helps cushion a joint by minimizing concussive forces. Strengthening protects joints from the abnormal or additional forces that can occur secondary to muscle weakness around a painful joint.  Specific muscle building exercises for the joint in question is imperative.

Goal # 4: Maintain full joint range of motion.  A joint gets its nutrition from lubricating all of its surfaces in synovial fluid (i.e. the fluid within the joint).  So, wherever the joint doesn’t get lubricated, that’s where the degenerative processes will start.  To stop this, your dog needs to be able to bend and straighten that joint fully.  You might do this manually, or you can find an exercise that will accomplish this.  For example, cavaletti walking at different heights, forcing the front and  hindlimbs to flex and extend is great for elbow and knee joint issues.

Goal # 5: Start the supplements immediately- from now till forever. There are a number of supplements that aim to improve cartilage health.  Vitamins, minerals, glycosaminoglycans, avocado-soybean unsaponifiable fractions, methylsulfonylmethane, s-adenosylmethionine, undenatured and hydrolyzed collagen preparations, phytoflavonoid compounds found in fruits, vegetables, spices, teas, and nuts, and other nutrients on the horizon. (4)

We are really only talking about early onset of arthritis or inflammation. Not everything we discussed today will be pertinent to your older more advanced dog. Be proactive. Talk to your rehab practitioner for input or your vet if they are well informed about these things.

In conclusion: can OA be reversed? Maybe if you are super proactive and catch it timeously.

 

References:

1.http://book.bionumbers.org/how-quickly-do-different-cells-in-the-body-replace-themselves/  accessed April 15, 2019.

2.Wodarz D.  Effect of stem cell turnover rates on protection against cancer and aging. J Theor Biol. 2007 Apr 7;245(3):449-58.

3.Goldring MB.  Update on the biology of the chondrocyte and new approaches to treating cartilage diseases.  Best Pract Res Clin Rheumatol. 2006 Oct;20(5):1003-25.

4.Lopez HL.  Nutritional interventions to prevent and treat osteoarthritis. Part II: focus on micronutrients and supportive nutraceuticals.  PM R. 2012 May;4(5 Suppl):S155-68.

5.Laurie Edge-Hughes, BScPT, MAnimSt (Animal Physio.), CAFCI, CCRT: Reversing Osteoarthritis, www.FourLeg.com 09 May 2020

 

 


Copyright by Dr. Michele Broadhurst 2020. All rights reserved.

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